TB Notes 1, 2000

National Jewish: The 100-Year War Against TB

by Jeff Bradley and
Michael Iseman, MD
Director, National Jewish Medical and Research Center
Denver, Colorado

National Jewish Medical and Research Center, which celebrated its
centennial in 1999, is known today for its expertise in a wide array
of respiratory, immunologic, allergic, and infectious diseases.
At the time of its founding, however, it had a single purpose: the
care of impoverished victims of TB.

The need for a TB hospital became acute in Denver in the 1880s.
In those days, people believed that the dry climate of the high
plains on which Denver is located would cure tuberculars (i.e.,
persons with TB disease). Consequently, many TB sufferers spent
their last dollars coming to Colorado. By the 1890s, it was estimated
that one out of every three residents of the state was there for
respiratory reasons.

Image 1: Picture of the Old National Jewish Hospital

In Denver, TB patients were literally dying on the streets. Boarding
houses often banned "lungers," as they were called, and
many of them were too sick to support themselves. A woman named
Frances Wisebart Jacobs recognized the need for a TB hospital and,
after joining forces with a young rabbi, the two raised enough money
to buy some land and erect a building, which was ready for patients
in 1893. Unfortunately, however, Denver was hit with the Silver
Crisis that year, and there was not enough money to open and run
the hospital.

This setback convinced the organizers that they should expand their
fundraising efforts beyond Colorado. The thinking in Denver was
that, since patients came there from all over the nation, people
all over the United States should help support the hospital. They
turned to B'nai B'rith, a national Jewish service organization,
and contributions came in from across the country. The building
finally opened in 1899 as the "National Jewish Hospital for
Consumptives."

National Jewish was the first hospital in the nation to focus exclusively
on indigent TB patients. As expressed in a singular motto, this
philosophy was "None may enter who can pay, none can pay who
enter." From day one, National Jewish was non-profit and non-sectarian.

The hospital opened with a capacity of 60 patients; the goal was
to treat 150 patients per year. This was made possible by putting
a 6-month limit on patient stays. Furthermore, National Jewish only
accepted patients in the early stages of TB. At least that was the
plan. In reality, however, several chronic sufferers were admitted,
and after a few months, the 6-month limit was lifted.

The treatment at National Jewish was in line with the protocols
at other turn-of-the-century TB sanatoria: plenty of fresh air,
lots of food, moderate exercise, and close scrutiny of every aspect
of patients' lives. The inhabitants of National Jewish, thus, could
expect to sleep outside — or with their heads outside — every night,
and were all but stuffed with food. In 1911, for instance, the annual
report records that National Jewish spent $3,631 on eggs — roughly
equivalent to $62,000 today — for just 120 patients.

In 1914, National Jewish erected a building for the study of TB;
this was the first place in which research on the disease was done
outside of a medical school setting. Other advances included the
nation's first self-contained facility for treating children with
active cases of TB and work on anti-TB drugs such as isoniazid (INH)
in the early 1950s. Later in that same decade, doctors at National
Jewish came up with a new protocol for TB that included abandonment
of bed rest and a substitution of physical activity; use of microbiological
assay measurements to determine the proper dosage of INH; and combined
drug therapy using streptomycin, INH, and para-aminosalicylic acid.

As TB gradually came under control in the United States, National
Jewish expanded its mission to include asthma and other respiratory
diseases, but maintained a strong presence in TB. Research continued
on better drugs, and the institution expanded its education efforts.
In 1963, the 1- to 2-week TB control course was offered for specialists
from all over the world, a course that is still offered today. Indeed,
over the past 20 years, nearly 5,000 physicians and nurses have
visited Denver for the course.

Rifampin, the most widely used drug for TB today, was tested at
National Jewish in 1970. Two years later, federal funds established
a state-of-the-art laboratory to study difficult TB cases. This
helped establish National Jewish as a highly specialized center
for drug-resistant TB and atypical mycobacterial infections.

Today, National Jewish continues to be a steady contributor in
the fight against TB. The hospital offers compassionate care to
victims of MDR TB, often providing treatment for the poor at no
charge. Leading pharmaceutical companies collaborate with National
Jewish to test new drugs. Perhaps the greatest contribution of National
Jewish is in education. In addition to the TB course, the hospital
maintains a Mycobacterial Consult Line, a free service whereby physicians
anywhere in the world can call up and receive advice from our specialists.
Over the past 5 years this service has responded to over 2,000 calls
annually.

At the opening of National Jewish back in 1899, the president of
the institution, speaking of TB in the exalted rhetoric of that
day, declared that it was his dream for the hospital "that
its doors may never close again until the terrible scourge is driven
from the earth." Now, at the time when the World Health Organization
estimates that one out of every three people in the world is infected
with TB, those doors are still open.

Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of Tuberculosis Elimination - http://www.cdc.gov/tb